Nevada Quietly Starts Implementing ObamacareSince 2011, Nevada has been quietly implementing a state exchange. Although the state joined the lawsuit against the Affordable Care Act, its governor said Nevada made a decision to build the exchange on their own. Pauline Bartolone looks at how a Republican governor is implementing the federal health care law.

Since 2011, Nevada has been quietly implementing a state exchange. Although the state joined the lawsuit against the Affordable Care Act, its governor said Nevada made a decision to build the exchange on their own. Pauline Bartolone looks at how a Republican governor is implementing the federal health care law.

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

This Friday, a notable deadline arrives as part of President Obama's health care law. States have until then to tell the federal government whether they'll set up their own health insurance exchanges. If they decline to do so, the federal government will step in to create the exchange. And that's what is likely to happen in many states controlled by Republican governors, including Alabama, which made that announcement today. But in Nevada, the GOP governor has opted to move forward with an exchange.

Pauline Bartolone of Capital Public Radio tells us more.

PAULINE BARTOLONE, BYLINE: Sandy Parcells is unemployed and one of more than a half million Nevadans who are uninsured. Now she's at the Sierra Nevada Health Center waiting for a follow-up appointment.

SANDY PARCELLS: I tried absolutely everything I could do to get some medical attention. And these guys were the only ones that could help me out. I even called the suicide hotline the day that I came in her. I was absolutely beside myself for help.

BARTOLONE: Before she found this clinic, she couldn't afford to go to the doctor to refill her migraine and antidepressant medication. And Parcells has other medical concerns. Her mom died of colon cancer, and Parcells herself can't afford to get a recommended colonoscopy.

PARCELLS: So I just wait, hope that I can get a job.

BARTOLONE: Nevada has one of the highest rates of uninsured people in the nation; more than one-in-five Nevadans lack coverage. The federal health law seeks to change that. And Nevada's Governor Brian Sandoval is one of a few Republican governors who's moving forward on a key part of the law.

GOVERNOR BRIAN SANDOVAL: We're in the process of building the exchange as we speak. It will be a place for Nevadans to go and see what the best opportunity is for them.

BARTOLONE: Nevada was one of the states that challenged the Affordable Care Act in court. But after it was upheld by the Supreme Court, Sandoval said it put a burden on states and he hoped Congress would act to change it. But he recognized the law might be here to stay. So since 2011, Nevada has quietly been building a state exchange.

SANDOVAL: Either the federal government was going to do it or the state would have to do it ourselves. And Nevadan's are fiercely independent. And so, we made a decision to build the exchange ourselves, which we have done. We are moving forward with that.

BARTOLONE: Right now, the exchange is little more than a website and a staff of eight working in Carson City.

CJ BAWDEN: The central health benefits...

BARTOLONE: CJ Bawden is the exchange's communications officer. He says they're setting up the exchange with federal money, but are preparing to be self sufficient in the future.

BAWDEN: In Nevada, the exchange runs as a business. We have no general funding from the State of Nevada. We're going to run as a business, charge fees as a business and stand on our own two feet.

BARTOLONE: Bawden says Nevada's exchange has been moving so fast it's become one of the first to test some of the federal guidelines for the states. He says the federal government has tweaked some rules as a result.

BAWDEN: We've been able to get out in front and push the edges. They're actually kind of looking to us for some information on different programs.

BARTOLONE: Bawden says Nevada is all set to announce to the federal government that they will operate on their own. He says Nevada's exchange will provide an open marketplace for insurers, with little regulation and lots of choices for consumers. And he's proud the state has stepped up.

BAWDEN: Right now, we're at a point where we're going to be ready to have a state-based exchange and avoid federal intervention. Whereas a lot of the other states that just went along the lawsuit path, are scrambling trying to figure out what they can do, if they can put together a state-based exchange in time, or if they're going to have to have a partnership or a completely federal exchange.

BARTOLONE: Bawden says the exchange is on schedule to start enrolling people in October 2013.

For NPR News, I'm Pauline Bartolone.

CORNISH: This story comes from a partnership with NPR, Capital Public Radio and Kaiser Health News.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.